Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 47122 | MN |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A77143 | CA |
NPI | 1013980390 |
---|---|
Provider Name | Dr. Andrea M Tom |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Carlos, CA 94070-2603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A771430 | (05) | CA |
370419000 | (05) | MN |
H83142 | (02) |